![]() ![]() Hereafter, we define SARS-CoV-2 testing as including both screening and diagnostic testing. Currently, the US Centers for Disease Control and Prevention recommends diagnostic testing for individuals with symptoms of COVID-19 and unvaccinated individuals in close contact with a confirmed or suspected COVID-19 case they also recommend screening tests for unvaccinated people, for example, for work, school, or travel. Though the SARS-CoV-2 diagnostic testing supply has increased, maintaining testing uptake remains a major US public health priority in the efforts to control community transmission in the current pandemic phase of vaccinations and variants. Unfortunately, insufficient SARS-CoV-2 testing in the United States throughout the first several months of the pandemic led to both undetected cases transmitting disease in the community and an underestimation of the burden of COVID-19. The importance of testing has been well demonstrated globally, such as in South Korea, where a “test, trace, isolate” strategy was largely credited for rapidly controlling transmission in spring 2020. Negative tests are often required for work, school, and leisure activities. Screening and diagnostic testing for SARS-CoV-2 infection is a critical tool in the public health response to the COVID-19 pandemic, as early detection allows for the implementation of isolation and quarantine measures to reduce community transmission. Simulation models predicted that testing uptake would increase from 81.6% (with a status quo scenario of polymerase chain reaction by nasal swab in a provider’s office and a turnaround time of several days) to 98.1% by offering additional scenarios using less invasive specimens, both viral and antibody tests from a single specimen, faster turnaround time, and at-home testing. In addition to variability in preferences for testing features, heterogeneity was observed in the distribution of certain demographic characteristics (age, race/ethnicity, education, and employment), history of SARS-CoV-2 testing, COVID-19 diagnosis, and concern about the pandemic. Among hesitant home testers (n=171, 3.6%), the venue was the most important attribute notably, this group was the most likely to opt out of testing. Noninvasive dual testers (n=1578, 32.9%) were most strongly influenced by specimen type and test type, preferring saliva and cheek swab specimens and both antibody and viral tests. Among dual testers (n=889, 18.5%), test type was the most important attribute, and preference was given to both antibody and viral tests. Fast-track testers (n=1235, 25.8%) were most influenced by result turnaround time and favored immediate and same-day turnaround time. Noninvasive home testers (n=920, 19.2% of participants) were most influenced by specimen type and favored less invasive specimen collection methods, with saliva being most preferred this group was the least likely to opt out of testing. Five distinct patterns of SARS-CoV-2 testing emerged. Of the 5098 invited cohort participants, 4793 (94.0%) completed the DCE.
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